[Cervical myelopathy revealing bone fluorosis]

Bone fluorosis is a rare metabolic disease characterized by massive bone fixation of fluorine. It is seen endemically around phosphate mines in North Africa. Neurologic complications, such as medullar compression may rarely reveal the disease. We report a case of cervical myelopathy due to bone fluorosis causing tetraparesis. Medullar compression was caused by posterior vertebral ligament calcification. Diagnosis was based on the characteristic radiologic aspect, and confirmed by the dosage of serum and urine levels of fluorine. Cervical laminectomy resulted in significant pain improvement, despite persistent motor deficit.

[Meningeal melanocytoma: a rare meningeal tumor]

Meningeal melanocytoma is a rare benign pigmented tumor. It develops from melanocytes normally present in the meninges of the posterior fossa and medulla. It is an extra axial tumor, that manifests due to compression of adjacent structures. The authors report a case of meningeal melanocytoma located at the foramen magnum. They insist on the characteristic paramagnetic signal of the tumor on the different MRI sequences.

[Primary psoas abscess in children: 6 cases]

BACKGROUND

Primary psoas abscess is very rare in childhood; its diagnosis and treatment can be improved by the use of recent imaging techniques.

PATIENTS

Six children, aged 11 months to 10 years (mean: 51 months) were admitted from January 1987 to 15 December 1993 because they suffered mainly from fever, lumbar pain and/or homolateral flexed hip. Examination showed a painful inguinal mass in five patients and hyperleucocytosis in all. X-rays showed disappearance of the external limit of psoas in two patients; ultrasonography showed enlarged psoas in all, associated with hypoechogenic mass in two and without echo in four patients. CT scan showed the abscess in all cases, permitting a needle aspiration for bacteriological studies: Staphycococcus aureus was present in five cases. Drainage of the abscess by CT-guided percutaneous catheter was performed in two patients. Surgical drainage was performed in three including one for whom percutaneous catheter drainage did not succeed. The two other patients were only given antibiotics.

CONCLUSION

CT-guided needle aspiration to establish presence and nature of fluid collection is a well established technique that may be extended to treatment of psoas abscesses.

[Osteochondroma of the mandibular condyle. Apropos of a case]

The authors report a case of mandibular condyle osteochondroma on a 33 years-old woman, similar to osteocartilaginous exostosis of the long bones. The lesion was revealed by a facial asymmetry and a change of the occlusion. The diagnosis was performed on the computed-tomography examination and histopathology. The removal of the lesion has conserved the condyle without recurrence after 20 months following-up. The authors remind the uncommonly location of osteochondroma in the facial skeleton and discuss the histogenesis of this lesion in its mandibular condyle site.

[Diagnosis of extruded herniated disks]

In a patient with disk herniation it is often difficult to establish that the disk is free in the spinal canal. A retrospective medical record study comparing 65 cases of free herniated disk (FHD) confirmed upon surgery and 65 cases of disk protrusion (DP) demonstrated that FHD was more common in young male blue collar workers, especially those who worked in the sitting position. No clinical findings were diagnostic of FHD although the straight-leg raising test was positive at smaller angles than in disk protrusion. In this study, sensitivity and specificity of CT scan for the diagnosis of FHD were 75% and 80%, respectively. CT scan findings suggestive of FHD included a free disk fragment, found in 22.5% of cases, and an acute connecting angle. Saccoradiculography was more sensitive but less specific than CT scan in this study. In FDH, migration was common and ragged hernia contours were seen on the saccoradiculography images.

Cerebral candidiasis. Computed tomography appearance

A three year old child who had been suffering from oral candidiasis since the age of 1 year presented with osteitis of the clavicle, 2 cerebral frontal abscesses and an occipital abscess which extended across the calvaria and was associated with osteolysis. Histological and microbiological studies following surgery confirmed the diagnosis of candidiasis in this girl who was found to have IgA immunodeficiency. The authors report the computed tomographic appearance of the cerebral lesions and review the literature.